Falling under the umbrella of Behavior Therapy, Cognitive Behavior Therapy (CBT), emphasizes how our context (environment) influences our thinking and how that influences how we feel and act.
The C in CBT stands for cognition (thinking, self-talk). As we go about our daily routine we are frequently engaging in private self-talk that no one but ourselves can hear. Like other behavior, our self-talk is strongly influenced by our history (the environment or context we have been a part of), the immediate context, and the consequences (what follows) our actions. We learn how to speak publicly (overtly) and privately (self-talk) in the same way as other behavior. Sometimes that self-talk is not helpful. For example, Joan (a fictitious name of a real patient) suffered from intense anxiety (heart racing, churning stomach, catastrophic self-talk) as the clock crept closer to the arrival of the mail or her husband coming home from work. Her self-talk focused on disaster and humiliation due to the significant change in their financial situation. Her self-talk was making her distress worse. Through CBT, Joan learned how to take committed action and become disentangled in her thoughts.
B is behavior. In this case, we are talking about actions. Doing stuff, like walking, swimming, reading, driving, or staying in bed. When we engage in actions they produce outcomes. The outcomes can be rewarding (“pleasant”) or aversive (“unpleasant”). Rewarding outcomes cause a specific action to occur more frequently in the future. In general, aversive outcomes have the opposite effect. Consider this example. Going for a walk requires effort (aversive) but it also is rewarding (seeing the budding trees and flowers, a change in scenery). However, there are some cases where aversive events following a behavior causes that behavior to be more likely. Consider this real example.
Shelly (a fictitious name and real patient) was in her 50’s and married. She struggled with depression, anxiety, chronic neuromuscular pain due to fibromyalgia and migraine headache. She also had neurologically-based vision problems. Like many other behavior disorders avoidance behavior is common but makes things worse. Shelly would avoid getting out of bed because when she did, it hurt (movement was aversive). Staying in bed prevented the initial pain and discomfort, but in the long haul it resulted in Shelly missing out on many rewarding activities and events. The more she stayed in bed the worse her depression, anxiety and pain became. CBT for Shelly resulted in her learning to pace her actions so she could experience rewarding events in her life and prevent pain flare-ups. She also learned how to combat the catastrophic self-talk.
T is for therapy. You know when you are receiving CBT when you see these components are an ongoing part of your treatment plan.
· Collaborative—The counselor and patient work together throughout the process identifying the target for change, treatment goals, treatment options, and supporting your successes and analyzing obstacles to living a values guided life.
· Action oriented—Patients are actively involved in the treatment process, through use of homework exercises that targets the problem behavior to learning new skills.
· Learning based—Patients acquire new cognitive and behavioral skills that are in session and used in situ by the patient.
· Present focused—Challenges in living occur because we encounter situations that trigger problematic self-talk or actions. It is these situations that must be managed because they are occurring now as is our distress.
· Brief by design—CBT is designed as a brief psychological intervention; 8-16 weeks compared to a lifetime of talking.
· Concrete—Challenges of living are translated into concrete targets for change (self-talk, actions) that can be measured and altered.
· Scientific—CBT has over 60 years of scientific research to support its use. Part of the scientific approach is through the use of homework exercises and measurement of targets for change.
For more information about how CBT can enable you to live a more rewarding life contact Dr. Duane A. Lundervold, Clinical Counseling Associates of Kansas City.
By: Duane Lundervold
PhD, LPC, BCBA-D